1. Chapter 28Chapter 28
The Child with a GastrointestinalThe Child with a Gastrointestinal
ConditionCondition

2. ObjectivesObjectives
• Define each key term listed.
• Discuss three common gastrointestinal
anomalies in infants.
• Discuss the postoperative nursing care of an
infant with pyloric stenosis.
• Discuss the dietary management of celiac
disease.
• Understand the symptoms, treatment, and
nursing care of a child with Hirschprung’s
disease.
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3. ObjectivesObjectives (cont.)(cont.)
• Understand the treatment and nursing care of a
child with intussusception.
• Interpret the nursing management of an infant
with gastroesophageal reflux.
• Differentiate among three types of dehydration.
• Explain why infants and young children become
dehydrated more easily than adults.
• Understand how nutritional deficiencies
influence growth and development.
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4. ObjectivesObjectives (cont.)(cont.)
• Review the prevention of the spread of thrush
in infants and children.
• Trace the route of the pinworm cycle and
describe how reinfection takes place.
• Prepare a teaching plan for the prevention of
poisoning in children.
• List two measures to reduce acetaminophen
poisoning in children.
• Indicate the primary source of lead poisoning.
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5. Overview of theOverview of the
Gastrointestinal (GI) TractGastrointestinal (GI) Tract
• Transports and metabolizes nutrients
necessary for the life of the cell
• Extends from mouth to anus
• Nutrients are broken down into absorbable
products by enzymes from various digestive
organs
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6. GI System Differences BetweenGI System Differences Between
Children and AdultsChildren and Adults
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7. Laboratory and Diagnostic StudiesLaboratory and Diagnostic Studies
• Clinical laboratory
– CBC with differential: anemia,
infections, chronic illness
– Erythrocyte sedimentation rate
(ESR) is indicative of
inflammation
– Comprehensive chemistry
panel will reveal electrolyte
and chemical imbalances
– Liver function test (LFT)
– Stool cultures
• X-ray studies
– GI series, barium enema, flat
plates of the abdomen
• Endoscopy allows direct
visualization and biopsy of
the GI tract
• Upper—esophagus,
stomach, duodenum, bile
and pancreatic ducts
• Can remove foreign
objects and cauterize
bleeding vessels
• Lower colon—
sigmoidoscopy
• Entire colon—colonoscopy
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8. Symptoms of GI DisordersSymptoms of GI Disorders
• Systemic signs
– Failure to thrive (FTT)
—failure to develop
according to
established growth
parameters
– Pruritus (itching) in the
absence of allergy may
indicate liver
dysfunction
• Local signs
– Pain
– Vomiting
– Diarrhea
– Constipation
– Rectal bleeding
– Hematemesis
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9. Nursing InterventionsNursing Interventions
• Focuses on providing adequate nutrition and
preventing infection
– Can result from malnutrition or depressed
immune function
• Developmental delays should be investigated
• Skin problems may be related to pruritus,
irritation from frequent bowel movements, or
other disorders
• Pain and discomfort need to be addressed
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10. Congenital DisordersCongenital Disorders
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11. Esophageal AtresiaEsophageal Atresia
(Tracheoesophageal Fistula [TEF])(Tracheoesophageal Fistula [TEF])
• TEF is caused by a failure of the tissues of the
GI tract to separate properly in prenatal life
• Four types
– Upper and lower esophagus (from the stomach) end in
a blind pouch
– Upper esophagus ends in a blind pouch; lower
esophagus (from stomach) connects to the trachea
– Upper esophagus is attached to trachea; lower
esophagus (from stomach) also attached to trachea
– Upper esophagus connects to trachea; lower
esophagus (from stomach) ends in a blind pouch
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12. Three Most Common Forms ofThree Most Common Forms of
TEFTEF
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13. Manifestations of TEFManifestations of TEF
• Earliest sign is when mother develops polyhydramnios
– If it ends in blind pouch, fetus cannot swallow amniotic fluid and it
will accumulate
– At birth, the infant will vomit and choke when the first feeding is
introduced
– Drooling may also be present at birth and is related to atresia
• If upper esophagus enters trachea, the first feeding will
enter the trachea and result in coughing, choking,
cyanosis, and apnea
• If lower end of esophagus enters trachea, air will enter
stomach each time infant breathes, causing abdominal
distention
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14. Nursing Care of TEFNursing Care of TEF
• Prevent pneumonia, choking, and apnea in
the newborn
– Assessment of the newborn during the first
feeding for signs/symptoms of TEF is essential
– Feeding usually is with clear water or
colostrum to minimize seriousness of
aspiration
• Surgical repair is essential for survival
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15. Imperforate AnusImperforate Anus
• Lower GI and anus arise from two different
types of tissue during fetal development
• Once the two meet, perforation occurs
allowing for a passageway
• When perforation does not take place, the
lower end of the GI tract and anus end in a
blind pouch
• Four types ranging from stenosis to complete
separation or failure of the anus to form
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16. Imperforate AnusImperforate Anus (cont.)(cont.)
• Manifestations
– Failure to pass meconium in the first 24 hours
must be reported
– Infant should not be discharged home until a
meconium stool has passed
• Treatment
– Once established, infant is NPO and prepared
for surgery
– Initial surgical procedure may be a colostomy
– Subsequent surgeries will reestablish patency
of anal canal
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17. Pyloric StenosisPyloric Stenosis
• Obstruction of the lower end of the stomach
caused by overgrowth of the circular muscles
of the pylorus or spasms of the sphincter
• Commonly classified as a congenital anomaly
• Symptoms usually do not appear until the
infant is 2 or 3 weeks old
– Most common surgical condition of GI tract in
infancy
• Incidence is higher in boys
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18. Manifestations of Pyloric StenosisManifestations of Pyloric Stenosis
• Projectile vomiting is outstanding symptom
from force or pressure being exerted on the
pylorus
– Vomitus contains mucus and ingested milk
– Infant is constantly hungry and will eat again
immediately after vomiting
• Dehydration and olive-shaped mass may be
felt in upper right quadrant of abdomen
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19. Treatment of Pyloric StenosisTreatment of Pyloric Stenosis
• Surgery is called pyloromyotomy
• Preoperative nursing care
– Intravenous fluids to treat or prevent dehydration
– Thickened feedings may be given by a teaspoon or through a
nipple with a large hole
– Burped before and during feedings to remove any gas
accumulated in the stomach
– Place on right side (preferably Fowler’s position) after feeding to
facilitate stomach drainage into the intestines
– If infant vomits, nurse is instructed to refeed the infant
• Postoperative nursing care
– Monitor intravenous fluids, provide feedings as prescribed by
surgeon, document intake and output, monitor surgical site
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20. Celiac DiseaseCeliac Disease
• Also known as gluten enteropathy and sprue
• Leading malabsorption problem in children
– Thought to be caused by inherited disposition
with environmental triggers
• Symptoms not evident until 6 months to 2
years of age when foods containing gluten
are introduced
– Wheat, barley, oats, and rye
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21. Celiac DiseaseCeliac Disease (cont.)(cont.)
• Repeated exposure to
gluten damage the villi
of intestines resulting
in malabsorption
• Characteristic profile is
abdominal distention
with atrophy of the
buttocks
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22. Celiac DiseaseCeliac Disease (cont.)(cont.)
• Infant presents with
failure to thrive
• Infant is irritable
• Stools are large,
bulky, and frothy
• Diagnosis confirmed
by serum
immunoglobin A (IgA)
and small bowel
biopsy
• Treatment
– Lifelong diet restricted
in wheat, barley, oats,
and rye
– Detailed parent
teaching is essential
• A professional nutritionist
or dietitian can aid in
identifying foods that are
gluten-free
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23. Hirschsprung’s DiseaseHirschsprung’s Disease
(Aganglionic Megacolon)(Aganglionic Megacolon)
• Absence of ganglionic innervation
to the muscle of a segment of
bowel
– Usually in lower portion of sigmoid colon
• Lack of normal peristalsis, results in
constipation
• Stools are ribbonlike due to feces
passing through the narrow
segment of colon
– Portion of bowel nearest obstruction
dilates, causing abdominal distention
– Seen more often in boys and in children
with Down syndrome
• May be acute or chronic
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24. Hirschsprung’s DiseaseHirschsprung’s Disease
(Aganglionic Megacolon)(Aganglionic Megacolon) (cont.)(cont.)
• Newborns: failure to pass meconium stools
within 24 to 48 hours may be a symptom
• Infants: constipation, ribbonlike stools,
abdominal distention, anorexia, vomiting, and
failure to thrive
• Young children: usually seen in clinic after
parents have tried over-the-counter laxatives
to treat the constipation
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25. Hirschsprung’s DiseaseHirschsprung’s Disease
(Aganglionic Megacolon)(Aganglionic Megacolon) (cont.)(cont.)
• If untreated, other signs
of intestinal obstruction
and shock may be seen
• Enterocolitis
(inflammation of the
small bowel and colon)
is a serious condition
– Fever, explosive stools,
and depletion of strength
• Diagnostics
– Barium enema
– Rectal biopsy
– Anorectal manometry
• Measures pressure in
anal sphincter
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26. Hirschsprung’s DiseaseHirschsprung’s Disease
(Aganglionic Megacolon)(Aganglionic Megacolon) (cont.)(cont.)
• Treatment
– Surgery to remove
impaired part of colon
and an anastomosis
of intestine is
performed
– In newborns, a
colostomy may be
needed until 12 to 18
months of age, when
more extensive repair
may be performed
• Nursing Care
– Dependent upon age of
child
– In newborns, detection is
high-priority
– As child grows, careful
attention to a history of
constipation and diarrhea
is important
– Signs of undernutrition,
abdominal distention, and
poor feedings are suspect
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27. Hirschsprung’s DiseaseHirschsprung’s Disease
(Aganglionic Megacolon)(Aganglionic Megacolon) (cont.)(cont.)
• Enemas
– Due to increased size of mucous membranes’
surface area, an increased absorption of the
fluid can be anticipated
• Therefore, normal saline solution should be used to
prevent water intoxication and death
– Parents should check with the pediatrician to
see how much saline should be administered
with each enema
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28. IntussusceptionIntussusception
• A slipping of one part of the
intestine into another part just
below it
– Often seen at the ileocecal valve
– The mesentery, a double fan-shaped
fold of peritoneum that covers most of
intestine and is filled with blood vessels
and nerves, is also pulled along
• Edema occurs
• At first, intestinal obstruction
occurs, but then strangulation of
the bowel occurs as peristalsis
occurs
• Affected portion may burst, leading
to peritonitis
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29. IntussusceptionIntussusception (cont.)(cont.)
• Generally occurs in boys
between 3 months and 6 years
– Frequency decreases after
age 36 months
• Can have spontaneous reduction
• Onset is usually sudden
– May have a fever as high as
106° F (41.1° C)
– As it progresses, child may
show signs of shock,
sweating, weak pulse, shallow,
grunting respirations;
abdomen is rigid
• In infants, severe pain in
abdomen, loud cries, straining
efforts, and kicking and drawing
of legs toward abdomen
• Child vomits green or greenish-
yellow fluid (bilious)
• Bowel movements diminish, little
flatus is passed
• Blood and mucus with no feces
are common about 12 hours
after onset of obstruction, called
currant jelly stools
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30. Treatment of IntussusceptionTreatment of Intussusception
• This condition is an emergency
• Diagnosis is determined by history and
physical findings
• May feel a sausage-shaped mass in right
upper abdomen
• Barium enema is treatment of choice, with
surgery if reduction does not occur
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31. Meckel’s DiverticulumMeckel’s Diverticulum
• Usually occurs near ileocecal valve and may
be connected to umbilicus by a cord
– A fistula may also form
– This sac is subject to inflammation
• Most common congenital malformation of the
GI tract
– Seen more often in boys
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32. Meckel’s DiverticulumMeckel’s Diverticulum (cont.)(cont.)
• Symptoms can occur
at any age, but
typically appear by 2
years of age
– Painless bleeding from
rectum
– Bright-red or dark-red
blood is more usual
than tarry stools
– Abdominal pain may or
may not be present
• Diagnostics
– Barium enema or radionuclide
scintigraphy are used in
diagnosing
– X-ray films are not helpful
• Treatment
– Surgical removal of the
diverticulum
• Nursing care is same for
any patient having
undergone abdominal
surgery
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33. HerniasHernias
• Inguinal
– Protrusion of part of the
abdominal contents through the
inguinal canal in the groin
• Umbilical
– Protrusion of a portion of the
intestine through the umbilical
ring
– Appears as a soft swelling
covered by skin, which protrudes
when infant cries or strains
33
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34. HerniasHernias (cont.)(cont.)
• May be present at birth
(congenital) or acquired
• Is reducible if it can be put
back into place by gentle
pressure
• If it cannot be put back, it is
irreducible or incarcerated
• Strangulated hernia is when
intestine becomes caught in
the passage and the blood
supply is diminished
• Child may vomit and
have severe abdominal
pain
• Emergent surgery is
indicated in this type of
situation
• In most cases, same-
day surgery is
performed
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35. Disorders of MotilityDisorders of Motility
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36. GastroenteritisGastroenteritis
• Involves inflammation
of the stomach and
intestines
• Colitis involves an
inflammation of the
colon
• Enterocolitis involves
an inflammation of
the colon and small
intestines
• Most common
noninfectious causes of
diarrhea
– Food intolerance
– Overfeeding
– Improper formula preparation
– Ingestion of high amounts of
sorbitol
• Priority problem in
diarrhea is fluid and
electrolyte imbalance
and failure to thrive
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37. GastroenteritisGastroenteritis (cont.)(cont.)
• Treatment is focused on identifying and
eradicating cause
• Priority goal of care is restoring fluid and
electrolyte balance
• Accurate intake and output, weighing of diapers,
observing for dehydration or overhydration, and
keeping infant/child warm
• Review with parents proper hand hygiene
techniques, safe food handling and storage,
principles of cleanliness, and infection prevention
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38. Clarifying Food LabelsClarifying Food Labels
• Children may have food allergies, so teach
parents the following
Ingredient What it may contain
Binder Egg
Bulking agent Soy
Casein Cow’s milk
Coagulant Egg
Emulsifier Egg
Protein extender Soy
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39. VomitingVomiting
• Results from sudden
contractions of diaphragm
and muscles of the stomach
• Persistent vomiting requires
investigation because it
results in dehydration and
electrolyte imbalance
– Continuous loss of hydrochloric
acid and sodium chloride from
the stomach can cause
alkalosis
– Can result in death if left
untreated
• Multiple causes of
vomiting
– Improper feeding
technique
– Systemic illness such
as increased
intracranial pressure
or infection
– Child at risk for
aspiration pneumonia
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40. VomitingVomiting (cont.)(cont.)
• Nursing care
– Carefully feed and burp
infant
– Place infant on side after
feeding to prevent
aspiration if vomiting occurs
– When an older child vomits,
turn head to one side and
offer emesis basin
– IV fluids may be ordered
– Slowly introduce foods to
allow stomach to rest
• Documentation
– Time, amount, color,
consistency, force,
frequency, and whether
vomiting was preceded by
nausea or feedings
– Administration of antiemetic
agents should also be
documented, including time
given and if/when vomiting
subsided
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41. Gastroesophageal RefluxGastroesophageal Reflux
• Lower esophageal sphincter is
relaxed or not competent,
allowing stomach contents to
regurgitate into esophagus
– Associated with neuromuscular
delay, such as Down syndrome or
cerebral palsy
• Often seen in preterm infants
• Symptoms often decrease
once child is able to stand
upright and eats more solid
foods
• Symptoms
– Vomiting
– Weight loss
– Failure to thrive
– Infant is fussy and
hungry
– Respiratory problems
can occur when
vomiting stimulates
closure of epiglottis and
infant presents with
apnea
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42. Gastroesophageal RefluxGastroesophageal Reflux (cont.)(cont.)
• History includes
– When vomiting started
– Type of formula
– Type of vomiting
– Feeding techniques
– Infant’s eating in general
• Tests include
– Barium swallow
– Esophageal sphincter
pressure
– pH monitoring—most
diagnostic
• Nursing care
– Careful burping
– Prevent overfeeding
– Proper positioning
– Feedings are thickened with cereal
• After being fed, infant is place in
an upright position or propped
– Sitting upright in an infant seat is
not recommended as it increases
intra-abdominal pressure
• Administer medications to relax
pyloric sphincter before meals
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43. DiarrheaDiarrhea
• Diarrhea in infant is a sudden increase in stools
from the infant’s normal pattern, with a fluid
consistency and a color that is green or contains
mucus or blood
– Acute sudden diarrhea most often caused by
inflammation, infection, or a response to medications,
food, or poisoning
– Chronic diarrhea lasts more than 2 weeks and may
indicate malabsorption problem, long-term
inflammatory disease, or allergic responses
– Infectious diarrhea caused by viral, bacterial, or
parasitic infection, usually involves gastroenteritis
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44. Symptoms of DiarrheaSymptoms of Diarrhea
• Stools watery and explosive; may be
yellowish-green
• Listlessness, refusal to eat, weight loss,
temperature may be elevated, possible
vomiting
• Dehydration evidenced by sunken eyes and
fontanel; dry skin, tongue, and mucous
membranes; less frequent urination
• In severe cases, excessive loss of
bicarbonate from GI tract results in acidosis
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45. ConstipationConstipation
• Difficult or infrequent defecation with the
passage of hard, dry fecal material
– May be periods of diarrhea or encopresis
(constipation with fecal soiling)
• May be a symptom of other disorders
• Diet, culture, and social, psychological, and
familial patterns may also influence
occurrence
• Daily use of laxatives or enemas should be
discouraged
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46. ConstipationConstipation (cont.)(cont.)
• Fewer than 7 bowel
movements in a 2-week
period
• Ask caregiver to define
constipation
• Evaluate dietary and bowel
habits
– Some infants develop
constipation due to high iron
content in formula
• Note frequency, color, and
consistency of stool
• Document any
medications child is taking
• Dietary modifications
include increasing
roughage in diet
– Foods high in fiber include
whole-grain breads and
cereals, raw vegetables and
fruits, bran, and popcorn for
older children
• Stool softener may be
prescribed
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47. Fluid and Electrolyte ImbalanceFluid and Electrolyte Imbalance
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48. Fluid and Electrolyte ImbalanceFluid and Electrolyte Imbalance
(cont.)(cont.)
• In children under 2 years of age, surface area is
important because more water is lost through
the skin than through the kidneys
• Metabolic rate and heat production are also 2 to
3 times greater in infants per kg of body weight
– Produces more waste products, which must be diluted
to be excreted
– Stimulates respirations, which increase evaporation
through the lungs
– Greater percentage of body water in children under 2
years is contained in extracellular compartment
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49. Fluid and Electrolyte ImbalanceFluid and Electrolyte Imbalance
(cont.)(cont.)
• Fluid turnover is rapid, and dehydration
occurs more quickly in infants than in adults
• A sick infant does not adapt as readily to shift
in intake and output
• Less able to concentrate urine and require
more water than an adult’s kidneys to excrete
a given amount of solute
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50. Fluid and Electrolyte ImbalanceFluid and Electrolyte Imbalance
(cont.)(cont.)
• Electrolyte balance depends on fluid balance
and cardiovascular, renal, adrenal, pituitary,
parathyroid, and pulmonary regulatory
mechanisms
• Signs of dehydration may not be evident until
the fluid loss reaches 4%, and severe
dehydration may not be evident until the fluid
loss reaches 10%
• Can treat with oral fluids or parenteral fluids
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51. DehydrationDehydration
• Causes fluid and
electrolyte
disturbances
• Evaluation of type
and severity, including
clinical observation
and chemical analysis
of the blood
• Types of dehydration
are classified
according to level of
serum sodium, which
depends on the
relative losses of
water and electrolytes
– Isotonic
– Hypotonic
– Hypertonic
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52. DehydrationDehydration (cont.)(cont.)
• Maintenance fluid therapy replaces normal
water and electrolyte losses
• Deficit therapy restores preexisting body fluid
and electrolyte deficiencies
– Shock is greatest threat to life in isotonic dehydration
– Children with hypotonic dehydration are at risk for
water intoxication
• Potassium is lost in almost all degrees of
dehydration and is replaced only after normal
urinary excretion is confirmed
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53. OverhydrationOverhydration
• The body receives more fluid than it can excrete
• Manifests as edema (excess fluid in interstitial
spaces)
– Interstitial fluid is similar to plasma, but contains little
protein
– Any factor causing sodium retention can cause edema
• Flow of blood out of the interstitial compartments
depends on adequate circulation of blood and
lymph
• Low protein levels disturb osmotic cellular pressure
• Anasarca is severe generalized edema
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54. OverhydrationOverhydration (cont.)(cont.)
• Treatment
– IV therapy is ordered and
child is monitored
– Is dependent upon type of
electrolyte imbalance child
has
– If child has a hypertonic type
of dehydration, tomato juice
should not be offered
– If child has a hypotonic type
of dehydration, plain water
should not be offered
• Nursing care
– Early detection and
management of edema are
essential
– Accurate daily weight, vital
signs, observing physical
appearance, and noting
changes in urine output
– Important for nurse to
monitor clinical laboratory
results and adjust fluids and
foods offered to the child
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55. Nutritional DeficienciesNutritional Deficiencies
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56. Failure to ThriveFailure to Thrive
• Failure to gain weight and
often lose weight
• Can be caused by
– Physical (organic) pathology
(OFTT), such as congenital
heart or malabsorption
syndrome
– Non-organic (NFTT) is from
the lack of parent-infant
interaction resulting from
environmental factors or
neglect
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57. Failure to ThriveFailure to Thrive (cont.)(cont.)
• Often admitted to hospital
• Presents with weight loss,
irritability, disturbances of
food intake, vomiting,
diarrhea, and general
neuromuscular spasticity
sometimes accompany the
condition
• Children fall below the third
percentile in weight and
height on standard growth
charts
• Development is delayed
• Due to multiple factors,
there may be a
disturbance in the mother-
child relationship
• Prevention of
environmental FTT
consists chiefly of social
measures
• Pregnancy history
sometimes reveals
circumstances that may
contribute to a lack of
mother-infant bonding
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58. Failure to ThriveFailure to Thrive (cont.)(cont.)
• Multidisciplinary approach in accordance with
circumstances
• In some cases, child is removed from home
environment and placed elsewhere
• Assigning the same nursing staff to care for
the child may increase nurturing and
interaction with the infant and parent
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59. Failure to ThriveFailure to Thrive (cont.)(cont.)
• Nurse is vital in supporting rather than in
rejecting the mother
– Encourages mother to assist with daily care of child
– Points out developmental patterns and provides
anticipatory guidance in this area
• Prognosis is uncertain
– Emotional starvation, particularly in the early years,
can be psychologically traumatic
– Inadequacies in intelligence, language, and social
behavior have been documented in children who fail
to thrive
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60. KwashiorkorKwashiorkor
• Severe deficiency of
protein in the diet despite
the fact that the number
of calories consumed
may be nearly adequate
• Belongs to a class of
disorders termed protein-
energy malnutrition
• Seen most often in third-
world countries
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61. KwashiorkorKwashiorkor (cont.)(cont.)
• Occurs in children 1 to 4 years of age who have
been weaned from the breast
– Oral intake is deficient in protein
– Child fails to grow normally
– Muscles become weak and wasted
– Edema of abdomen
– Diarrhea, skin infections, irritability, anorexia, and
vomiting may be present
– Hair thins and is dry and may contain a white streak
– Child looks apathetic and weak
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62. KwashiorkorKwashiorkor (cont.)(cont.)
• Treatment is mainly preventive
• Simple protein powder sprinkled on the
culturally prepared meal will alleviate the
problem
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63. RicketsRickets
• Caused by deficient amounts of vitamin D
– Exposure to sunshine is necessary for proper
absorption and metabolism of calcium and
phosphorus
• Classic symptoms are bow-legs; knock-
knees; beading of the ribs, called rachitic
rosary; and, improper formation of teeth
– Vitamin supplements along with exercise and
exposure to outdoor sunlight is primary form of
treatment
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64. ScurvyScurvy
• Caused by insufficient fruits and vegetables
that contain vitamin C
• Symptoms include joint pain, bleeding gums,
loose teeth, lack of energy
• Vitamin C
– Easily destroyed by heat and exposure to air
– Not stored in the body and daily intake of the vitamin
is necessary
• Vitamin supplements and dietary intake such
as citrus fruits and raw leafy vegetables
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65. InfectionsInfections
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66. AppendicitisAppendicitis
• Most common reason for
emergency abdominal surgery
– Small appendage arising
from the cecum
– Lumen may become
obstructed with fecal matter
or with lymphoid tissue after
a viral illness or with
parasites
– Stasis, increased swelling,
edema, and growth of
organisms
• Initial pain usually in
periumbilical and
increases within a 4-
hour period
• When inflammation
spreads to peritoneum,
pain localizes in RLQ of
abdomen
• Appendix may become
gangrenous or rupture
• Can lead to peritonitis
and septicemia
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67. AppendicitisAppendicitis (cont.)(cont.)
• Characteristic
symptoms
– Tenderness in RLQ,
known as
McBurney’s point
– Guarding
– Rebound tenderness
– Pain on lifting thigh
while in supine
position
– Pain in RLQ
• Diagnostics can include
– Blood tests
– Abdominal X-ray
– CT scan
– Ultrasound
• Treatment
– Surgical intervention typically
required
• Nursing care is the same as
with most other abdominal
surgery patients
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68. Thrush (Oral Candidiasis)Thrush (Oral Candidiasis)
• Usually caused by a
fungus, Candida
• Anorexia may be present
• Systemic symptoms are
generally mild if infection
remains in the mouth; can
pass into GI tract causing
inflammation of the
esophagus and stomach
• Responds well to local
application of antifungal
suspension, such as
nystatin
– Medication should
remain in contact with
“patches” as long as
possible
• With proper care, the
condition disappears
within a few days after
onset
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69. WormsWorms
• Pinworms (Enterobiasis)
– Looks like a white thread;
lives in lower intestine but
lays eggs outside anus
– Eggs become infective
within hours of being
deposited
– Route of entry into the
body is through the mouth
– “Scotch tape” test
• Antihelminth
medications are given
for both types of worm
infestations
• Roundworms (Ascariasis)
– Seen more in U.S. southern states
and among immigrants and migratory
workers
– Caused by unsanitary disposal of
human feces and poor hygiene
– Eggs can survive for weeks in soil
– If child eats soil, eggs develop into
larvae in intestine, penetrate
intestinal wall and enter liver; from
there, the worms circulate to the
lungs and heart
– Chronic cough without fever is
characteristic of this form of
infestation
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70. Patient TeachingPatient Teaching
• Main nursing responsibility is educating
parents and child about the prevention of
worm infestation through general hygiene,
food handling and preparation, as well as
through environmental controls
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71. PoisoningPoisoning
• Goals of treatment
– Remove the poison
– Prevent further absorption
– Call the poison control center
– Provide supportive care—seek medical help
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72. Detecting the Poison byDetecting the Poison by
Specific Odor of VomitusSpecific Odor of Vomitus
Odor of Vomitus Probable Content
Sweet Chloroform, acetone
Bitter almond Cyanide
Pear Chloral hydrate
Garlic Phosphorus, arsenic
Shoe polish Nitrobenzene
Violet Turpentine
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73. PoisoningPoisoning (cont.)(cont.)
• General concepts
– Volume of swallow
– Principles of care—education
– Poison control centers—nationwide phone
number is 1-800-222-1222
– Ipecac syrup—no longer recommended
– Activated charcoal—given for some
substances
– Charcoal or any gastric lavage is not effective
if administered after 1 hour post-ingestion
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74. Poisonous PlantsPoisonous Plants
Plant Causes symptoms of
Azalea, Buttercup, Marigold Aconitine poisoning
Lantana, Jimsonweed Atropine poisoning
Sweet pea, Black mountain laurel Curare poisoning
Apricot or peach pits, Elderberry Cyanide poisoning
Camellia seeds, Foxglove, Oleander Similar to digitalis poisoning
Goldenrod, Nightshade, Poinsettia Nitrate poisoning
Laurel, Water hemlock Resin poisoning
Camellia, Marigold, Tulips, Violets Salicylate poisoning
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75. Selected OTC DrugsSelected OTC Drugs
that Are Deadly to Toddlersthat Are Deadly to Toddlers
Generic name Trade name Toxicity
Benzocaine Orajel Methemoglobinemia, seizures
Camphor Vicks VapoRub
Campho-Phenique
CNS depression, seizure
Diphenoxylate Lomotil CNS depression
Methyl salicylate Oil of wintergreen
Icy-hot balm
Arthritis ointment
Cardiovascular collapse
Phenylpropanolamine Many decongestants
such as Afrin and
Sudafed
Hypertension, intracranial
bleeding, cardiac arrhythmia,
CNS depression, seizures
Tetrahydrozoline
hydrochloride
Visine eye drops Tachycardia
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76. Safety AlertSafety Alert
• Many over-the-counter medications are
considered harmless by parents but can be
deadly to the toddler or small child
• Keep all medications (prescription or
otherwise), including herbal supplements, out
of reach of small children
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77. Poisons CommonlyPoisons Commonly
Encountered in PediatricsEncountered in Pediatrics
• Acids
• Alkalines
• Medications
• Cyanide
• Ethanol
• Petroleum distillates
• Carbon monoxide
• Lead
• Arthropods, insect
stings
• Snakes
• Poisonous plants
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78. Lead Poisoning (Plumbism)Lead Poisoning (Plumbism)
• Results when a child repeatedly ingests or
absorbs substances containing lead
• Incidence higher in inner-city tenements
• Children who chew on window sills and stair rails
ingest flakes of paint, putty, or crumbled plaster
• Eating nonfood items is called pica
• Can have a lasting effect on the CNS, especially
the brain
• Mental retardation occurs in severe cases of
lead poisoning
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79. Lead Poisoning (Plumbism)Lead Poisoning (Plumbism) (cont.)(cont.)
• Symptoms occur gradually
– Lead settles in soft tissues and bones
– Is excreted in urine
• Beginning stages, signs may be weakness,
weight loss, anorexia, pallor, irritability,
vomiting, abdominal pain, and constipation
• Later stages, signs may be anemia and
nervous system involvement
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80. Lead Poisoning (Plumbism)Lead Poisoning (Plumbism) (cont.)(cont.)
• Lead is toxic to the synthesis of heme in the
blood, which is necessary for hemoglobin
formation and renal tubule functioning
• Blood lead levels are primary screening test
• X-ray films of bones may show further lead
deposits
• History may reveal pica
• Treatment is aimed at reducing concentration of
lead in blood
– Chelating agents may be taken for several months
• Prognosis depends on extent of poisoning
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81. Foreign BodiesForeign Bodies
• 80% of all ingestions occur in children
between 6 months and 3 years of age
– About 80% of items ingested pass through the
GI tract without difficulty
– May take up to 6 days to occur
• Caution parents not to use laxatives and to
maintain a normal diet to avoid intestinal
spasms
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82. Review QuestionReview Question
• What should the nurse monitor before
administering intravenous fluid to a child who
is dehydrated?
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83. ReviewReview
• Objectives
• Key Terms
• Key Points
• Online Resources
• Review Questions
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